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The Neural Hierarchy and the Stroke Survivor

“We have a brain for one reason and one reason only, and that’s to produce adaptable and complex movements.” This quote may come as a surprise. As we are often only concerned with our client’s muscles, joint, lungs, and hearts. The reality is that all training is brain training, we just don’t think of it that way.

pelvic-floor-illustration

Pelvic Floor: Lower Region Muscles with Big Responsibilities

The area of the body referred to as your pelvic floor are the muscles that are used to urinate, pass bowel movements, and for sexual intercourse. When or if these muscles weaken, there can be uncomfortable and inconvenient interferences for someone’s day to day living. The side effects of having a weak pelvic floor are negative, so taking preventative measures can be important and incorporating exercises to strengthen these muscles is necessary. We need to be in control of squeezing and relaxing these muscles, although most of the time this is done automatically. 

Your pelvic floor muscles are your core. These include your abdominal muscles, back muscles, and your diaphragm. They wrap around the pelvic bone to tailbone and then extend on both sides of the pelvis. If you want to feel where these muscles are you can squeeze the urethra to stop yourself from peeing or squeeze your anus to stop yourself from passing gas. There are two main muscles of the pelvic floor which are the levator ani (which has three parts) that wraps around the entire pelvic and the coccygeus which is located near the back of the pelvis. 

There are a few reasons the pelvic floor can weaken over time. Childbirth, trauma, and surgery are the most common culprits. These muscles are stressed during pregnancy. Hormonal changes in women as they age, particularly during menopause, can weaken the muscles. Persons with diabetes are also at higher risk for weaker pelvic floor muscles. Certain conditions can also weaken them. These would include stress incontinence, urge incontinence, anal incontinence, fecal incontinence, and what is called pelvic organ prolapse. Stress incontinence happens to many women post childbirth and for men post prostate surgery. This is when you might dribble pee when you sneeze, cough, laugh, and/or lift something. Urge incontinence is the constant feeling of needing to pee. Anal incontinence is having a hard time controlling when you pass gas, and fecal incontinence is having a hard time controlling bowel movements. Pelvic organ prolapse is when the muscles including the uterus, bladder, and rectum might bulge into the vagina and cause a protrusion. 

Treatment depends on the severity of the condition. There are natural approaches to do this, but surgery could be required. Kegel exercises would be the first measure. Kegels are an effective exercise which involves squeezing and relaxing the pelvic floor muscles, focusing on controlling the sensation. Squeezing time can start with 3 seconds and increase to 8 to 12 seconds over time. Exercises shouldn’t be done if there has been trauma or injury to the area unless cleared by a medical professional. There are trained physical therapists to guide and assist with pelvic floor exercises as well. Avoiding constipation if possible is also helpful. This could include lifestyle changes revolving around diet, activity, and medications. 

Most people don’t even think about their pelvic floor muscles until a problem arises. Natural aging brings about new areas of the body we become aware of and took for granted at younger ages. As with all areas of our health, being proactive rather than reactive is desired. It’s important to address health issues even if the topic is embarrassing or private. Helping ourselves helps others and there are natural measures we can take without extreme invasive procedures. 


Originally printed on Every BODY’s Fit blog. Reprinted with permission.

Dr. Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health and a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

References:

Pelvic floor muscle exercise and training for coping with urinary incontinence – PMC (nih.gov)

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice – PMC (nih.gov)

sleep-women

Sleep and CVD: What Can Midlife Women Do?

It was the scorching summer of ’96 when I received a call that rocked my world—my 60 year old mother had suffered a stroke. This powerful woman’s life changed forever. Years later, my brother, a firefighter whose sleep was frequently interrupted by alarms, tragically lost his life to a heart attack. These personal stories illustrate the profound effects of sleep on heart health, particularly for midlife women.

The Hard-Hitting Stats: Focused on Midlife Women

Let’s dive into the statistics that underscore the importance of this issue specifically for midlife women:

  • Stroke Alert: 20% of midlife women will encounter a stroke by the age of 55. This statistic is drawn from the National Stroke Association, highlighting the elevated risk for this demographic.
  • Death by Stroke: Women account for 57% of stroke deaths, a significant gender disparity in stroke mortality rates reported by the American Heart Association.
  • Race and Risk: Black midlife women face disproportionately higher mortality rates from strokes, pointing to an urgent need for targeted health interventions, as noted by the National Institutes of Health.
  • Heart Disease Dominance: Over 60 million women, many in their middle years, live with heart disease, the leading cause of death for women, outpacing all cancers combined. These figures are supported by data from the Centers for Disease Control and Prevention (CDC).

Research Revelations: The SWAN Study by Rebecca Thurston, PhD

Dr. Rebecca Thurston’s research utilized the Study of Women’s Health Across the Nation (SWAN), a multi-decade study initiated in 1996. Focusing on 2,517 women whose sleep patterns were monitored through midlife for 22 years, the study involved 16 different interviews where participants self-reported their sleep habits. Here’s what they found:

  • Long-term Insomnia Risks: Women with persistent insomnia throughout midlife have a 70% increased risk of developing cardiovascular diseases, revealing the critical impact of sleep quality on heart health.
  • Impact of Sleep Quality: Those with persistent insomnia and short sleep exhibited a 75% increased risk of cardiovascular issues, emphasizing the importance of both sleep quantity and quality.

What Can Midlife Women Do?

So, what actionable steps can midlife women take to mitigate these risks? Here are some effective strategies:

  • CBT-I for Better Sleep: Cognitive Behavioral Therapy for Insomnia (CBT-I) helps develop healthy, drug-free sleep patterns and is endorsed by numerous sleep studies and health organizations as an effective treatment for insomnia.
  • CPAP for Sleep Apnea: For those disrupted by sleep apnea, using a CPAP machine can significantly improve sleep quality.
  • Lifestyle Tweaks: Engaging in morning exercises and avoiding blue light exposure from electronic devices in the evenings can greatly enhance sleep quality and overall heart health.

This isn’t just about discussing sleep; it’s about taking actionable steps to improve heart health for midlife women. By transforming personal loss into proactive health strategies, we aim to advance this conversation together and ensure every moment is lived to its fullest.


Ren Jones is your guide through the health maze, specialized in nutrition, fitness and menopause, dedicated to improving the lives of midlife women since 2014. You can catch more insights on his podcast, “This Podcast Has No Name,” (Apple and Spotify) where he delves deep into these vital health topics.

Female-Trainer-and-older-male-client

Patients Need Personal Trainers: How personal training can impact millions

In the United States, 11.2 million people were diagnosed with obesity and/or diabetes over the last year.(1,5) These are primary risk factors leading to stroke and total joint replacements, adding another 8 million people per year.(6,7) This means that the fitness professional in the post-medical and post-rehabilitation space has more potential clients than they could hope to serve. The question is how to reach them and build a business around these problems.

Personal Trainer and marketer Joe Lemon has some advice.  Two primary problems for trainers trying to innovate this post medical/rehabilitation space are trust and visibility. Both these problems are interrelated and so deserve to be tackled for this space to become profitable.

In the United States, less than 50% of physicians suggest patients go to a gym. Even less (20%) recommend a personal trainer.(4) But the question is, why? First, we found a general ignorance of what personal trainers can do for their clients and, secondarily, if personal training was a safe, effective modality. This is partially due to a lack of standardization in personal training education and regulation across the USA. In addition, until recently, there has been a lack of specific training for fitness professionals in the medical fitness space that can be understood and trusted.

Even for those exceptional personal trainers who do provide the training to address specific clients’ post-medical/rehabilitation needs, there is a gap between their skills and clinicians’ knowledge that they exist. Joe has practical advice to close that gap and create a bridge to clinicians.

First, identify who these clinicians are. Sports medicine, orthopedic surgeons, neurologists, bariatric doctors and primary care physicians are all viable referral sources. Network and get to know someone who can make personal introductions for you directly to the doctor or their assistant or office manager, who is often the gatekeeper of the practice. Once you get the opportunity to talk to them, give them tangible, always take a pamphlet explaining your qualifications, education, and process. Providing them with hard copy printouts from the MedFit websites (medfitnetwork.org and medfitclassroom.org) are the most accessible sources of information you could use. And always, leave them with the material they can give their patients that link directly back to you in the form of business cards and pamphlets/brochures.

Lastly, get out and talk about what you do. Remember, communication is 7% what you say where 38% how you speak it, and 55% your body language.(3) Getting in front of people these days is easier now than ever. Schedule talks at gyms and coffeehouses, video it, and post it online. The more you talk passionately about what you love doing, the better. Connect with your potential client recruit them to be your spokesperson to their physician for you.


Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

References

  1. (CDC), U. D. (2021). 2020, National Diabetes Statistics Report. 
  2. Lemon, J. (2021). Business Development, Market Research, & Strategic Partnerships. (G. Higgins, Interviewer)
  3. Michail, J. (2020, 8 24). Strong Nonverbal Skills Matter Now More Than Ever In The “New Normal”. Retrieved from Forbes: https://www.forbes.com/sites/forbescoachescouncil/2020/08/24/strong-nonverbal-skills-matter-now-more-than-ever-in-this-new-normal
  4. Pojednic, R., Bantham, A., Arnstein, F., Kennedy, M., & Phillips, E. (2018). Bridging the gap between clinicians and fitness professional: a challeng to implimenting exercise as medicine. BMJ Open Sport & Exercise Medicine, 1-5.
  5. CDC f. (2021, 3 1). National Center for Health Statistics. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/hus/contents2019.htm#Table-021
  6. Springer, B. D. (2021). Highlights of the 2020 American Joint Replacement Registry Annual Report. Arthroplasty Today, 9, 141-142.
  7. Stroke. (2021, 5 25). Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/stroke/facts.htm
trainer-senior-client-stretch

Health and Disease Spans: Can You Change It?

Sam is a 90-year-old client of mine who comes into the clinic every day, walks for 30 minutes on the treadmill, then jumps on the elliptical for 15 minutes following by another 15 minutes on the stationary bike. After he’s done with his cardio, he knocks off 10 pull-ups, unassisted, and then he finishes the rest of his strength program. He feels energetic and enjoys spending time with his family and friends. On the other hand, Bob, a client who came in a few months ago, is 62 years old, sleeps in a recliner most nights because his back pain is too severe to stay in bed. He is an attorney working long hours with high levels of stress. His long hours keep him from exercising on a regular basis, he is a borderline diabetic and has recently started Lisinopril to control his newly diagnosed hypertension.

What’s the difference between my two clients? Sam has experienced a long and successful health span. At 90, his disease span has barely started to show. Bob, on the other hand, has an early onset disease span. He is losing his function and productivity while experiencing a slow and steady decline into the abyss.

There are several factors that influence the onset of one’s disease span. Factors such as genetic predisposition, lifestyle choices and sleep patterns are just a few examples that will influence the shape of your disease span curve. Often, the interrelatedness of influencing factors dictate our life’s outcome. By understanding our history, recognizing the triggering events that have occurred over time and managing mediators affecting our health, we are in the unique position to have a positive impact on our health/disease span curve.

Regardless of your previous lifestyle choices, you can create a big change. It is amazing how quickly our bodies respond to positive changes. In as little as 30 days, I have seen people decrease their need for medication, increase their energy, improve their sleeping habits and become more engaged in their personal relationships.

Remember Bob, in 45 days he was off his pain medication, sleeping in bed and played 9 holes of golf which is something he hadn’t done in 5 years. It is essential to understand your lifestyle history to take the necessary steps in making a well-rounded change. Success begins when you work with the right professional to re-write your story which will in turn elongate your health span, shorten your disease span and result in dying young at a ripe old age.


Jim Herkimer, DPT, MS, ATC  has been involved in health, fitness and rehabilitation for over 35 years. He is currently the CEO and Executive Director at Sports Conditioning and Rehabilitation (SCAR) in Orange, California. SCAR is a wellness and rehabilitation clinic providing a continuum of care for individuals through the life span. Throughout his career, he has had the opportunity to help a variety of athletes and individuals from all walks of life reach beyond their potential. 

Geriatric-Elderly-Fitness

What does the word “geriatric” mean to you?

geriatrics\ ˌjer-​ē-​ˈa-​triks  , ˌjir-​\ : a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging people.

What does the word geriatric mean to you? Oftentimes, it comes with a negative connotation. It’s time to change the perception of this word in the fitness industry.

In the medical fitness space, we seek to align with doctors and health professionals.

Geriatric medicine physicians (Geriatricians) work to promote health by preventing and treating diseases and disabilities. To a great degree, this includes improving functional abilities and independence in their activities of daily living. With the rapid growth of the older population in the US, the demand for geriatric medicine is higher than ever.

Physicians specializing in geriatric medicine work closely with interdisciplinary teams, including physical therapists and fitness professionals, to implement care plans that will improve quality of life. This is where a properly educated fitness professional can enter, collaborate with doctors and make a huge impact in the lives of this population.

Senior Fitness vs. Geriatric Fitness

Senior fitness is popular in the fitness industry and many organizations offer education for working with seniors — but it’s primarily focused on seniors who are “generally healthy”.  Senior fitness is centered on preventative measures to maintain existing health as a person ages.

But not all seniors fall into this category. In fact, most do not. Geriatric fitness is for those who are not healthy,  who need guidance with fitness and lifestyle changes to improve degraded function so they can perform activities of daily living and be independent.

Why Specialize?

Specializing in geriatric fitness allows you to reach a huge market (there are over 70 million baby boomers with 10,000 people reaching age 65 daily!), but you’ll also find it to be a fulfilling part of your career. You’ll find creating programming for this group intellectually stimulating and challenging. You’ll also find it emotionally rewarding — helping geriatric clients make small improvements in their health will have an enormous impact on their quality of life, independence and well-being.

You’ll also offer peace of mind to caregivers — often adult children — as they are frequently the ones seeking an educated fitness professional to help their aging parent.

It’s time to see the word geriatric in a new, positive light. A personal trainer specializing in geriatric fitness is helping a senior maintain independence, prevent life-threatening falls and manage chronic health conditions to live their highest quality of life through their golden years.

Become a Geriatric Fitness and Lifestyle Specialist

Align yourself with the medical community and become a Geriatric Fitness and Lifestyle Specialist! Check out MedFit Classroom’s first of its kind online course for fitness professionals.



References

Stroke-Brain-MRI

Trainer Challenge of Stroke

A stroke is an obvious turning point in most survivors’ lives. In a best-case scenario, it can be as minor as a mild concussion. At worst, it is a disabling brain injury that leaves the person incapable of caring for themselves—or even breathing on their own. In any case, stroke clients can provide a significant challenge to a trainer wanting to help them, once medical care and primary rehabilitation has plateaued. This is especially true considering the variety of experiences a survivor can have, following a stroke.

Female-Trainer-and-older-male-client

Training Clients with Arthritis

According to the CDC, during 2019-2021, 1 in 5 adults in the United States experienced doctor-diagnosed arthritis. Since then, the number has consistently increased! The latest statistics from Health.Gov estimate the number of reported arthritis diagnoses is now 1 in 4, which is not only a leading cause of disability, but also a significant driver of economic costs.